Assessment of drug prescription practises in chronic hemodialysis patients: case series.

Introduction: The aim of the study was to assess the quality of drugs prescriptions in chronic haemodialysis patients. Material and methods: The authors conducted a prospective study in chronic haemodialysis patients of two haemodialysis centres in the city of Oujda eastern Morocco, during the year of 2020. The authors identified the drugs prescribed in this population with regards to the product characteristics, in terms of indications, contraindications, dosage and drug interactions. Our data were analyzed by SPSS version 27 software. Results: The mean number of drugs taken per patient was 8.15±6. Ninety-three percent of patients received treatment for anaemia. Phosphocalcic disorders and hypertension were treated in 89% and 72% of patients, respectively. In 77.6% of the cases, these drugs were taken orally. According to Vidal, the majority of prescriptions met the criteria of good prescription, in 81.54% of the cases, versus 18.46% of the patients with at least one of non-compliant prescription. On the other hand, 6.15% of the patients had at least one inadvisable combination. No contraindicated association was noted in our patients. Conclusion: Patients undergoing haemodialysis have a higher risk of developing side effects and drug interactions than patients with normal kidney function. Given the paucity of pharmacokinetic studies in this population, nephrologists refer to their own experience to treat his patients effectively.Therapeutic education and regular monitoring of chronic haemodialysis patients can improve clinical outcomes, quality of life and reduce the cost of care.

Current Knowledge of Beta-Blockers in Chronic Hemodialysis Patients.

Beta-blockers include a large spectrum of drugs with various specific characteristics, and a well-known cardioprotective efficacy. They are recommended in heart failure, hypertension and arrhythmia. Their use in chronic hemodialysis patients is still controversial, mainly because of the lack of specific randomized clinical trials. Large observational studies and two important clinical trials have reported almost unanimously their efficacy in chronic hemodialysis patients, which seems to be related to their levels of dialyzability and cardioselectivity. A recent meta-analysis suggested that high dialyzable beta-blockers are correlated to a reduced risk of all-cause mortality and cardiovascular complications compared with low dialyzable beta-blockers. Despite their benefits, beta-blockers may have adverse effects, such as intradialytic hypotension with low dialyzability beta-blockers or the risk of sub-therapeutic plasma concentration of high dialyzable ones during dialysis sessions. Both cases are linked to adverse cardiovascular events. A solution for both high and low dialyzable drugs could be their administration after dialysis sessions. Futhermore, the bulk of existing literature seems to favor cardioselective beta-blockers with moderate-to-high dialyzability as the ideal agents in dialysis patients, but further, larger studies are needed. This review aims to analyze beta-blockers' characteristics, indications and evidence-based role in chronic hemodialysis patients.

Long-term patency of bypass to the right atrium as a last resort in two hemodialysis patients: case report.

Introduction: Central venous occlusion (CVO), which is caused by central venous catheters in haemodialysis patients , remains a challenge in vascular surgery. Case presentation: The authors report data evaluating bypass graft patency and complications of two patients with CVO who have benefited from a subclavian artery to right atrium bypass using polytetrafuloroetylene. The first patient , underwent three times an angioplasty of the atrio prothetic anastomosis , finally the graft failed at 12 month. The second one, presented a steal syndrome with ischaemia of the right upper limb immediately postoperatively. Three months after the procedure , she underwent an angiographic control that showed a stenosis of the protheto atrial junction. Clinical discussion: Central venous occlusion in patients with end-stage kidney disease is most often due to central venous catheters. Although the endovascular therapy is the first-line approach to the treatment of CVO, the surgical bypass to the right atrium is often the last resort to preserve adequate vascular access in haemodialysis patients, with CVO. The autologous vein and bovine arterial bypass remains better than polytetrafuloroetylene grafts in terms of long-term patency. Only few cases have been reported un the literature , besides no long-term outcome data has been previously reported. Conclusion: Long-term secondary patency of bypass to the right atrium can be achieved, but requires strict follow-up, and multiple endovascular procedures to maintain the bypass access.

The SARS-CoV-2 responsible for phlegmasia cerulea dolens: a case report.

Coronavirus disease 2019 (COVID-19) is a worldwide pandemic systemic infection that is responsible for serious coagulopathies similar to disseminated intravascular coagulation. Case Presentation: The authors report the case of a COVID-19 patient who presented with phlegmasia cerulea dolens (PCD) of the left lower limb, so he benefited from aponeurotomies of the internal and anterolateral muscular compartments. Clinical Discussion: The severe acute respiratory syndrome coronavirus 2 involves an inflammatory process in thrombotic events in COVID-19 patients, including a cytokine storm. PCD evolves in three semiological phases: venous stasis, weakening of the pulses, and the constitution of major ischemia. In the literature, the authors find many reports that have been published regarding increased thrombus formation in COVID-19 patients; these include DVT formation, pulmonary embolism, and stroke. Nevertheless, publications concerning PCD in COVID-19 patients remain rare. Conclusion: Although the severe acute respiratory syndrome coronavirus 2 remains a thrombogenic pathology, systematic anticoagulation is the subject of hypothesis. Hence the importance of regular monitoring of markers of vascular thrombosis.

Right subclavian artery to right atrium bypass using Polytetrafluoroethylene (PTFE) graft in hemodialysis patient with central venous occlusion: Case report.

Introduction: Central venous Occlusion (CVO) is a serious complication that occurs mainly in patients with long term central venous catheters for dialysis. It remains a challenge in vascular surgery. Case presentation: We report a case of a patient with end-stage kidney disease (ESKD), who was admitted for chronic occlusion of the superior and inferior vena cava and underwent a right subclavian artery to right atrium (RA) bypass using polytetrafuloroetylene (PTFE) graft. Clinical discussion: Central venous catheters remains the main cause of CVO in ESKD. Although the endovascular therapy is the main approach in the treatment of CVO, the surgical bypass to the RA is often the last resort to preserve vascular access in hemodialysis patients. The autologous vein and bovine arterial bypass remains better than PTFE grafts in terms of long term patency. Conclusion: fistulas as a first approach for dialysis access must be privileged at the expense of central catheters. However bypass to RA by mini thoracotomy incision remains as an excellent option for dialysis access in ESKD with CVO.

Is There Gender Discrimination in Living-Donor Kidney Transplantation?

Kidney transplantation is the ideal treatment for patients with end-stage kidney disease as it provides better survival and quality of life. The best form is living donor kidney transplantation. Numerous studies documented significant gender inequality when it comes to receiving or donating a kidney transplant among women. This article will summarize the present knowledge of gender-related kidney transplantation and discuss the potential causes for the observed disparities and their consequences.

Cutaneous necrosis of the arteriovenous fistula puncture site in chronic hemodialysis: A historical complication or an ever-present threat? A series of 26 cases.

INTRODUCTION: Cutaneous necrosis (CN) at the puncture site of the arteriovenous fistula (AVF) in chronic hemodialysis (CHD) is a rare but potentially fatal complication. The objective of our work was to establish the associated complications, vascular prognosis, and patient survival of CHD patients presenting cutaneous necrosis. METHODS: This retrospective study (January 2016 to March 2020) was conducted in the Department of Vascular Surgery and the Department of Nephrology at the University Hospital Center Mohammed VI of Oujda, Morocco. Included were all CHD patients admitted for treatment of cutaneous necrosis at the puncture site of a native AVF. RESULTS: Data from 26 cases were collected. The mean age was 58.7 ± 16 years, 70.8% were female, and 25% had diabetic nephropathy; 42.3% of the AVFs were radiocephalic and 46.1% were brachiocephalic; 42.2% of patients presented active bleeding, of whom 91% required a blood transfusion; 80.8% of the AVFs were complicated by aneurysms. Fistulography showed stenosis in 42.3% of cases. Urgent surgical intervention was performed on all the patients. Fifty percent of patients required placement of a short-term hemodialysis catheter. Two patients had presented a recurrence. Death occurred in one case following a massive hemorrhagic shock. CONCLUSION: Cutaneous necrosis is a relatively common complication and requires early screening and immediate surgical intervention.

Morocco's First Biobank: Establishment, Ethical Issues, Biomedical Research Opportunities, and Challenges.

BACKGROUND: Biobanks are highly organized infrastructures that allow the storage of human biological specimens associated with donors' personal and clinical data. These infrastructures play a key role in the development of translational medical research. In this context, we launched, in November 2015, the first biobank in Morocco (BRO Biobank) in order to promote biomedical research and provide opportunities to include Moroccan and North African ethnic groups in international biomedical studies. Here, we present the setup and the sample characteristics of BRO Biobank. METHODS: Patients were recruited at several departments of two major health-care centers in the city of Oujda. Healthy donors were enrolled during blood donation campaigns all over Eastern Morocco. From each participant, personal, clinical, and biomedical data were collected, and several biospecimens were stored. Standard operating procedures have been established in accordance with international guidelines on human biobanks. RESULTS: Between November 2015 and July 2020, 2446 participants were recruited into the BRO Biobank, of whom 2013 were healthy donors, and 433 were patients. For healthy donors, the median age was 35 years with a range between 18 and 65 years and the consanguinity rate was 28.96%. For patients, the median age was 11 years with a range between 1 day and 83 years. Among these patients, 55% had rare diseases (hemoglobinopathies, intellectual disabilities, disorders of sex differentiation, myopathies, etc.), 13% had lung cancer, 4% suffered from hematological neoplasms, 3% were from the kidney transplantation project, and 25% had unknown diagnoses. The BRO Biobank has collected 5092 biospecimens, including blood, white blood cells, plasma, serum, urine, frozen tissue, FFPE tissue, and nucleic acids. A sample quality control has been implemented and suggested that samples of the BRO Biobank are of high quality and therefore suitable for high-throughput nucleic acid analysis. CONCLUSIONS: The BRO Biobank is the largest sample collection in Morocco, and it is ready to provide samples to national and international research projects. Therefore, the BRO Biobank is a valuable resource for advancing translational medical research.

Attitudes, Knowledge, and Social Perceptions toward Organ Donation and Transplantation in Eastern Morocco.

The study is aimed to assess attitudes, knowledge, and social perceptions toward organ donation and transplantation in Eastern Morocco and therefore understand what sets back this activity's expansion and progression. We conducted a cross-sectional study involving three groups of persons that are theoretically involved in the process of organ donation (medical students, law students, and nurses). Data were collected using an anonymous questionnaire related to the cultural, religious, medical, and legal aspects of organ donation and transplantation. Six hundred questionnaires were distributed. The participation rate in the study was 71%, with female predominance and participants were mainly from an average socioeconomic level. Fifty- one percent of the participants were medical students. About 87.1% had already heard about organ transplantation in Morocco, but most of them felt that they were not sufficiently informed. 57.9% of the participants were favorable with some reluctance to organ donation, 28.7% were unconditionally favorable, and 5.9% were totally unfavorable. Only 46% of the participants accepted living organ donation, whereas 47.1% did not. Moreover, 64.7% of the participants accepted organ donation after their death, evoking the desire to help others and save lives. According to our survey, 55.1% of our participants considered that the decision to donate their organs after death belongs to them. About 44.9% think they should discuss this decision with their relatives and 50% said their culture and religion influence their decisions. Our work did reveal an insufficient level of awareness about various aspects of the topic. Moreover, a high pro-portion of the participants did not have positive attitudes toward donating, mainly driven by religious, cultural beliefs and perceived risks to the donor. The reasons of refusal should be analyzed carefully to improve acceptability toward organ donation and transplantation.

Current Knowledge of Vaccinations in Chronic Kidney Disease Patients.

Chronic kidney disease (CKD) patients are at high risk for infectious complications. This is partly due to their dysfunctional immune system, especially in advanced CKD stages. Vaccination represents an important prevention strategy in these patients, as several studies have reported lower infection rates and significantly reduced morbidity and mortality in hospitals adopting vaccination protocols. However, vaccination rates are particularly low in these patients, and the diminished immune responsiveness remains the main issue of vaccination in CKD patients. Besides, there are various immunization protocols across the world in the absence of optimal vaccination policies. This paper aims to discuss the current knowledge of vaccination in this immunocompromised group of patients based on recent evidence and recommendations.

Application of the Concepts of Social Responsibility, Sustainability, and Ethics to Healthcare Organizations.

Corporate social responsibility (CSR) is a concept that has varied through history, with evolving definitions that aim to determine the interconnections between corporations and community. Currently, in addition to ethics, this concept of social responsibility is increasingly considered in the context of healthcare delivery suggesting a new paradigm in hospital management. Sustainability is another emerging strategic goal for healthcare systems and organizations. In this opinion paper, we briefly discuss the application of social responsibility, sustainability and ethics to healthcare organizations.

Ovarian tumor and glomerulopathies: case report and review of the literature.

We describe a patient who developed nephrotic syndrome in the setting of ovarian tumor. A kidney biopsy showed minimal change nephropathy (MCN). CT scan and MR imaging followed by surgery lead to diagnostic of ovarian dermoid cyst. Surgery combined with corticosteroids resulted in a complete remission of nephrotic syndrome with disappearance of proteinuria after 3 weeks. Ten other cases of ovarian tumor associated with glomerulopathy are reviewed. This is the second case of an ovarian teratoma associated with MCN. Accurate history, physical examination, laboratory data, and kidney biopsy are highlighted in establishing the correct diagnosis in such patients.

[Therapeutic compliance: another challenge for patients on chronic haemodialysis]. / L'observance thérapeutique: un autre défi à relever chez l'hémodialysé chronique.

Poor compliance with therapy is frequently encountered in most of patients with chronic diseases. It increases the risk of morbi-mortality and healthcare costs. Patients on chronic haemodialysis often have poor compliance with treatment. This study aims to assess the level of compliance with treatment in our patients on chronic hemodialysis and to identify the predictive factors of poor compliance with treatment. We conducted a cross-sectional study at the Oujda Hospital in November 2011. The compliance with treatment was measured using a questionnaire: the compliance evaluation test (CET) assessed the compliance with medication treatment and diet. A rate of 85% was retained arbitrarily as a threshold for good compliance with treatment. Patient in a zone of partial adherence had a rate between 57% and 85% while a lower rate (57%) indicated poor compliance with treatment. Different demographic and clinicobiologic parameters were analyzed and predictive factors for good and poor compliance with treatment were identified. Our study involved 101 patients on chronic haemodialysis; the sex ratio was 1.2, the average age of patients was 15.6 years. CET showed that 23.4% of patients had good compliance with treatment, 39.4% partial compliance with treatment and 37.2% poor compliance with treatment. Statistical analysis showed that poor compliance with treatment was associated with a lower socio-economic and intellectual status, with co-morbidities and with long term hemodialysis. Good compliance with treatment was observed in very old patients helped by a third person, taking a reduced number of medications, with a higher intellectual level.

[Nephrogenic syndrome of inappropriate antidiuresis]. / Syndrome d'antidiurèse inappropriée néphrogénique.

Disorders of water balance are a disease commonly encountered in our clinical practice. Analysis of vasopressin receptor type II (V2R) is essential to understand the physiology of water balance and it is used as a biological prototype of G protein-coupled receptors (GPCRs). Nephrogenic syndrome of inappropriate antidiuresis (NSIAD) is a syndrome of inappropriate antidiuretic hormone secretion (SIADH) with low plasmatic vasopressin. The evidence on the role of V2 receptor and of aquaporin (AQP) in the mechanism of action for antidiuretic hormone (ADH) was based on the identification of protein gene mutations in patients with nephrogenic diabetes insipidus and NSIAD syndrome. V2R activating mutations were found in patients with NSIAD, contrasting with the numerous V2R inactivating mutations related to X-linked mutations described in patients with nephrogenic diabetes insipidus.

La ponction biopsie rénale: indications, complications et résultats.

Renal needle biopsy (RNB) is the gold standard in the diagnosis of kidney diseases. It is an invasive technique causing several complications, in particular hemorrhagic events. This study aims to evaluate our RNB practice, to update the current understanding of the technique for percutaneous renal biopsy, to assess complications and to determine the prevalence of kidney diseases diagnosed in our region. We conducted a retrospective study between January 2015 and June 2017. Sixty-nine patients hospitalized in the Division of Nephrology at the University Hospital Mohamed VI Oujda having undergone native kidney biopsy were included in the study. The average age of patients, at the time of RNB, was 38.16 ±13 years [12-77 years], with a sex ratio (M/F) of 0.86. Nephrotic syndrome was the most frequent indication for RNB in all age groups. Glomerular kidney diseases accounted for 81% of kidney diseases, divided as follows: extra-membranous glomerulonephritis in 19% of patients, focal and segmental hyalinosis in 18%, lupus nephritisin in 11%, chronic glomerulonephrites in 11%, membranoproliferative glomerulonephritis in 7%, extracapillary glomerulonephritis in 5% shared equally with renal amyloidosis. Four percent of RNB showed diabetic nephropathy. Histopathological examination revealed acute post-infectious glomerulonephritis, minimal glomerular lesion, immunoglobulin A (IgA) nephropathy, vasculitis, tubulo-interstizial nephropathies as well as thrombotic microangiopathy, with an estimated rate of 2% respectively. Five percent of RNB showed non-glomerular disease. Macroscopic haematuria was the main complication observed in our case series, with a rate of 2.8%. RNB is the gold standard in the diagnosis of renal disease. However, syndromic diagnosis enables clinician to identify the most probable renal disease and to guide any emergency treatment.

Does smoking increase the risk of progression of nephropathy and/or cardiovascular disease in type 2 diabetic patients with albuminuria and those without albuminuria?

UNLABELLED: Diabetic nephropathy is the primary cause of chronic kidney disease and is associated with increased cardiovascular mortality. Cigarette smoking is probably the most complex and the least understood among the risk factors for chronic kidney disease and cardiovascular disease in diabetic patients. The aim of this study was to determine the impact of smoking on progression of nephropathy and cardiovascular disease in type 2 diabetic patients with albuminuria and those without albuminuria. METHODS: This is a prospective study. The Ethics Committee of Morocco's Mohammed V University in Rabat approved the study protocol. Inclusion criteria targeted patients who were type 2 diabetics and who had nephrology follow up for at least 36 months. RESULTS: A total of 671 cases of T2D were included. Mean age of all patients was 65 ± 11 years and 12.1% were smokers. There was no statistically significant difference between T2D patients with albuminuria according to absence of presence of smoking at the time of enrollment, at 1 year and 3 years of follow-up, concerning the median albumin excretion rate (mg/day): 98 [56-281] vs. 124 [56-323] (p=0.59); 98 [56-281] vs. 124 [56-323] (p=0.15) and 98 [56-281] vs. 124 [56-323] (p=0.52) respectively. There was a statistically significant difference between T2D patients with albuminuria according to absence or presence of smoking at the time of enrollment and the end of follow-up, concerning cardiovascular events: 56 (12.3%) vs. 19 (28.4%) (p<0.001) and 66 (14.5%) vs. 19 (28.4%) (p=0.004) respectively. CONCLUSION: Smoking remains one of the most important modifiable risk factors for progression of renal and cardiovascular disease in diabetic patients, thus adding to the burden of morbimortality.

Mixed cryoglobulinemia-associated Sjögren's syndrome leading to spontaneous rupture of the kidney: a case report.

BACKGROUND: Spontaneous rupture of the kidney is uncommon and is mainly caused by renal tumors. Only a few cases are caused by vasculitis. We report here the first case of spontaneous rupture of kidney resulting from mixed cryoglobulinemia. CASE PRESENTATION: A 44-year-old man presented with sudden onset of fever, acute pulmonary edema, left flank abdominal pain unassociated with trauma, and rapidly progressive renal failure requiring dialysis. Computed tomography of the abdomen revealed a large perirenal hematoma of the left kidney. During conservative surgery, the patient underwent renal biopsy that showed renal vasculitis and membranoproliferative glomerulonephritis with intracapillary microthrombi. Tests were positive for mixed cryoglobulinemia caused by Sjögren's syndrome. The patient was better after immunosuppressive therapy, with the disappearance of clinical symptoms and the recovery of baseline renal function. CONCLUSION: We report on this case and discuss a possible link between spontaneous rupture of kidney and mixed cryoglobulinemia-associated Sjögren's syndrome.

Albuminuria in type 2 diabetes mellitus: from remission to progression.

OBJECTIVE: Albuminuria is an early marker of renal impairment and a powerful factor of progression of renal disease in type 2 diabetes (T2D). Approximately, one-third of patients with T2D have micro- or macroalbuminuria and these patients have a high risk of progression toward End Stage Renal Disease (ESRD) as well as increased cardiovascular disease. The aim of this study was to determine the prevalence of remission, regression, persistence, and progression of albuminuria, and to evaluate the impact of change in albuminuria on kidney disease and cardiovascular disease in a prospective cohort of patients with T2D. METHODS: This is a prospective study. The Ethics Committee of Morocco's Mohammed V University in Rabat approved the study protocol. Inclusion criteria targeted patients who were type 2 diabetics with albuminuria >30 mg/day, and who had been regularly followed-up in nephrology consultation for at least 36 months. RESULTS: Five-hundred twenty-four patients were included. 75.8 and 24.6% of all patients had micro- and macroalbuminuria at enrollment in the study. At the end of the study, 91, 141, 199, and 93 patients had remission, regression, persistence, and progression of albuminuria, respectively. Remission of microalbuminuria to normoalbuminuria was observed in 23.6% of cases. Regression of macroalbuminuria to micro- was observed in 29.9% of cases. CONCLUSION: In our study, the incidence of remission and/or regression of micro- and macroalbuminuria was higher. The incidence of ESRD and the occurrence of cardiac events were greater in the regression, persistence, and progression groups than in the remission of albuminuria group.

Adrenal Insufficiency and Mild Rhabdomyolysis Revealing a Human Immunodeficiency Virus Infection: A Case Report.

The spectrum of human immunodeficiency virus (HIV) endocrinopathy is large. Adrenal insufficiency (AI) is common in both early and late stages of HIV syndrome, resulting in significant morbidity and mortality. However, rhabdomyolysis is a muscle disease in which striated muscle fibers disintegrate, excreting myoglobin in the urine, leading to acute kidney failure. It is currently reported that rhabdomyolysis may be a direct result of the HIV infection, especially in the advanced stages of HIV/AIDS disease. This case study reports AI and a mild rhabdomyolysis in a patient with no medical history and no medicine or toxic intake. Laboratory assessment revealed HIV infection.